Anaphylaxis Insect Bites and Injections

Anaphylaxis (anaphylactic shock) is an immediate type of hypersensitivity reaction leading to peripheral circulatory collapse (152). Anaphylaxis is estimated to cause about 500 deaths annually in the United States (153). Anaphylaxis is triggered by the release of histamine and other inflammatory mediators from tissue mast cells (152). Activation of mast cells is the result of interaction of an allergen and a specific IgE antibody on the mast cells, but certain drugs and diagnostic agents also...

Injury From Smoke Inhalation

Smoke interferes with normal airway clearance by respiratory epithelium, causes bronchospasm, and affects surfactant-producing pneumocytes (104,108,112). Inhalation Systemic Complications Post-Burn Significant in the Determination of the Cause of Death Neurological complications from carbon monoxide (CO) poisoning hypoxic-ischemic encephalopathy (100). Inhalation injury (smoke, toxic agents, hot gas, e.g., steam) (94,98,100,102,103). Acute laryngeal edema. Eventual necrotizing or...

Abdominal Compartment Syndrome

The normal pressure of the peritoneal cavity is at most atmospheric and varies inversely with intrathoracic pressure during respiration (398). Intra-abdominal pressure (IAP) is elevated when any type of severe abdominal trauma is associated with massive fluid resuscitation, hemoperitoneum, bowel edema, attempted surgical closure of a non-compliant abdominal wall, and use of intra-abdominal packing. Circumferential burn eschar causes extrinsic compression (see Chapter 4, Subheading 5.2.)....

Internal Injuries Owing to Electrocution Table

Electrocution Histopathology Pictures

Hospitalized electrocution victims can show evidence of myocardial ischemia and arrhythmias 139,141,145,147,149,152,158 . Because of the onset of arrhythmia can be delayed, these patients are monitored for 24 h after admission, particularly when there is a history of heart disease, loss of consciousness at the scene, or apparent current flow through the heart 139,141,142,145,232,233 . The heart can be normal at autopsy 181 . Petechiae may be found in the myocardium, and larger hemorrhages have...

Electrical Burns and Other External Trauma

Electrical Burns

Direct contact is the most common mechanism of injury 158 . The greater the skin resistance, the more likely that burns will result 141 . A smaller surface area of Fig. 31. Electrocution burns contact or entry site . A Worker's glove. B Burn on hands. Courtesy of Dr. D. King, Regional Forensic Pathology Unit, Hamilton, Ontario, Canada. contact means a greater current intensity and severity of injury 158,163 . Skin burns can be absent even in high-voltage electrocutions, if the contact area is...

External Examination of a Submerged Body

Drowning Froth

Froth meringue-like is expressed around the mouth and nostrils in a typical wet drowning see Headings 10. and 12. Fig. 3 and refs. 6 and 16 . Froth can be washed away by the action of water before body retrieval, disappear after the body has been in the open, or removed before transfer of the body for autopsy 3 . Froth may be not seen by investigators at the scene 3 . In one study, external foam was observed in only 19 of cases 3 . Fig. 3. Wet drowning. Froth from nose and mouth. Fig. 3. Wet...

Pharyngeal and Gastric Contents

Terminal aspiration of sterile acidic gastric contents and oropharyngeal secretions containing bacteria occurs frequently as an agonal event and is often observed at autopsy 395 . Cough and gag reflexes are depressed at death, allowing agonal regurgitation into the airway 396 . This is not necessarily a cause of death, but a sign that an individual is obtunded 36,209,333,396 . Psychiatric and neurological disorders that lead to choking cause aspiration of vomit 397 . Aspiration of gastric...

External Examination of Hanging Deaths

Strangulation Ligatur

Dependent livor is observed in the lower arms and legs depending on the duration of suspension see Chapter 2, Fig. 9 and ref. 23 . Ropes, electric cords, and belts are common 23,24,43,50,57,58 . The ligature may be altered, i.e., unraveled or cut by next of kin and investigators 16 . The ligature can be wound multiple times Fig. 8 refs. 5, 24, and 62 . The ligature can be simply looped around the neck or there can be an elaborate knot e.g., multiple loops in a hangman's noose 16,46 . An...

Livor Mortis Livor Lividity Postmortem Hypostasis Postmortem Suggilation

Lividity Postmortem

Because of the cessation of blood flow at death, there is gravitational settling of blood that distends capillaries and veins, resulting in discoloration of skin in the non-compressed dependent areas of the body Fig. 9 . Slight hypostasis has been described in living individuals dying from a prolonged illness and terminal circulatory failure 4 . Patchy lividity 1- to 3-cm or about 0.5- to 1-in. areas has been described in nonde-pendent areas of the body and attributed to venous blood being...

Info

B., Schmeckpeper, K., Strope, M. Jail suicides by hanging. An epidemiological review and recommendations for prevention. Am. J. Forensic Med. Pathol. 8 27-31, 1987. 87. Copeland, A. R. Fatal suicidal hangings among prisoners in jail. Med. Sci. Law 29 341-345, 1989. 88. He, X. Y., Felthous, A. R., Holzer, C. E., III, Nathan, P., Veasey, S. Factors in prison suicide one year study in Texas. J. Forensic Sci. 46 896-901, 2001. 89. Topp, D. O. Suicide in prison. Br. J. Psychiatry 134...

Chest Compression and Cephalic Petechiae

The jugular venous system divides into the more superficial external jugular vein EJV and the internal jugular vein IJV . Not all veins of the head and neck are valve-less. The IJV valve is situated 0.5 to 2 cm up to 0.75 in. above the union of the subclavian and internal jugular veins 30 . The valve normally prevents retrograde blood flow to the brain when there is increased intrathoracic pressure e.g., coughing 30 . In individuals with a normal central venous pressure CVP , coughing creates...

Plastic Bag Asphyxia

Bag Asphyxia

Plastic bag asphyxia results from decreased oxygen concentration in the available inspired air and physical obstruction of the mouth and nose 257 . The latter mechanism arises when a plastic bag becomes electrically charged and adheres to the face, aided by Fig. 51. Plastic bag asphyxia suicides . knotting and tying of three plastic bags. Fig. 51. Plastic bag asphyxia suicides . knotting and tying of three plastic bags. A Elderly woman. B Neck pallor created by condensation 242,257 ....

Variants of Decomposition

Postmortem Drying The Tongue

Drying mummification is a variant of decomposition. Localized drying can affect the tip of the partly exposed tongue, the lips, the tips of fingers and toes, and the scrotum Figs. 32-34 . If the eyelids are not closed after death, then scleral drying appears as a horizontal brown line taches noires scl rotiques see Fig. 35 . Another eye change is corneal clouding. It occurs 2 to 3 h after death if the eyes are open, and by 24 h if they are shut 6,8 . Generalized transformation of skin to a...